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Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding Bill & Melinda Gates Foundation.

"Introduction: diabetes mellitus (DM) is one of the most prevalent non-communicable diseases. Spatio-temporal study of DM has a main in the design of disease prevention programs. The present study aimed to describe the spatio-temporal distribution of diabetic patients in the Iranian military community. Methods: In this ecological study, all registered cases of DM in the Iranian military community (military officers and enrolled conscripts) were considered during the period 2015-2019. Getis-Ord Gi statistics was applied to identify the DM hotspots. Spearman Correlation Coefficient was used to perform trend analysis of the disease. Results: The number of DM incident cases in the military officers and enrolled conscripts was 1135 and 85, respectively. Isfahan (n=153) and Tehran (n=67) for the military officers and Zanjan (n=17) and Kurdistan (n=10) for the enrolled conscripts were the provinces with the highest number of identified DM cases. In the study period, no significant hotspots were detected in the military officers; However, an increasing trend of DM was observed (CC= 0.935, p 0.001). The DM hotspots detected in enrolled conscripts were as follows: 2015 – Qom (95% CI); 2016 – Lorestan, Qazvin, and Guilan (90% CI); 2017 – Ilam, Hamadan, and Markazi (90% CI); and 2018 – Ilam (95% CI), Alborz, Qom, Markazi, Lorestan, Kermanshah (90% CI), and no significant trend was noticed nonetheless (CC=-0.160, p=0.555). Conclusion: It appeared that Northern and North-Western Iran were high-risk areas for DM in the military population and should be considered in designing the diabetes prevention and control program. Moreover, the determination of DM risk factors in the aforementioned areas could play a crucial role in the prevention of the disease. "

Introduction: Trauma is one of the most common causes of death in the world. E-Fast ultrasound can detect the haemoperitoneum, intravenous pneumothorax, and hemothorax. In this study, we evaluated the accuracy of E-FAST focused ultrasound in blunt trauma patients referred to the Emergency Department. Methods: In this study 167 blunt trauma patients were included. E-FAST is performed from four standard spaces in terms of free fluid, chest in terms of hemothorax, and pneumothorax. Ultrasound is performed on the trauma patient and the obtained results were compared with the result of the standard gold CT scan test. All patient information including age, sex, mechanism of trauma, patient ISS, E-FAST result, and CT scan result were registered. Results: Overall, 174 patients were included that 45 (25.9%) of them were females. The mean age of the patients was 38.39±12.31 years. E-FAST had a sensitivity of 66.7 and a specificity of 100% in the diagnosis of hemothorax. Also, a positive predictive value of 100% and a negative predictive value of 99.4% were detected for 120 people in both normal tests. Conclusion: The results show E-FAST is a suitable alternative to CT scan in the diagnosis of hemothorax, pneumothorax, and free fluid in the abdomen, vulva, and pericardial cavity. Due to portability, safe body, no need for contrast, fast performance, as well as cheapness, and reproducibility, it will be a great help in diagnosing trauma-related lesions and prompt and timely treatment. CT scan should be used only in limited cases and special indications.

As COVID-19 hounds the world, the common cause of finding a swift solution to manage the pandemic has brought together researchers, institutions, governments, and society at large. The Internet of Things (IoT), Artificial Intelligence (AI) — including Machine Learning (ML) and Big Data analytics — as well as Robotics and Blockchain, are the four decisive areas of technological innovation that have been ingenuity harnessed to fight this pandemic and future ones. While these highly interrelated smart and connected health technologies cannot resolve the pandemic overnight and may not be the only answer to the crisis, they can provide greater insight into the disease and support frontline efforts to prevent and control the pandemic. This paper provides a blend of discussions on the contribution of these digital technologies, propose several complementary and multidisciplinary techniques to combat COVID-19, offer opportunities for more holistic studies, and accelerate knowledge acquisition and scientific discoveries in pandemic research. First, four areas where IoT can contribute are discussed, namely, i) tracking and tracing, ii) Remote Patient Monitoring (RPM) by Wearable IoT (WIoT), iii) Personal Digital Twins (PDT), and iv) real-life use case: ICT/IoT solution in Korea. Second, the role and novel applications of AI are explained, namely: i) diagnosis and prognosis, ii) risk prediction, iii) vaccine and drug development, iv) research dataset, v) early warnings and alerts, vi) social control and fake news detection, and vii) communication and chatbot. Third, the main uses of robotics and drone technology are analyzed, including i) crowd surveillance, ii) public announcements, iii) screening and diagnosis, and iv) essential supply delivery. Finally, we discuss how Distributed Ledger Technologies (DLTs), of which blockchain is a common example, can be combined with other technologies for tackling COVID-19.

Preparation and hospital development estimated an essential part of the policies and strategic purposes of healthcare in each government. Today, applications of management to reduce the burden of natural and technical disasters appear are very necessary. Objectives: The study aimed to review the major relevant articles in the case of the application of telemedicine for trauma injuries in disaster and military situations. Methods: Original clinical trials investigating the effects of telemedicine on trauma injuries published before April 2018 were aggregated, and used in this study. We search the scientific sources such as PubMed, MEDLINE, Wiley, EMBASE, ISI, and Scopus. The keywords that applied to identify these articles combined: Telemedicine, Mobile Health, Health, Mobile, mHealth, Telehealth, eHealth, Trauma, War, military, medicine, Wounds and Injuries, injuries. Results: The text of the articles and abstracts were examined from various aspects, the 21 articles were evaluated for quality, and then 10 papers entered in a systematic review. We found that the use of telemedicine in trauma injury, rural and the military is very helpful for high-quality trauma care; also the telemedicine and telephone consultations can be were demonstrated reducing the risk of physician-related medicine mistakes. The economic evaluation of telemedicine was demonstrated cost-saving and cost-effective of telemedicine consultations. We also realized the importance and practicable of telemedicine for improving rural trauma care. Conclusions: Ultimately, the telemedicine can help patients and health government organizations economically, the telemedicine consultations due to cost-saving and cost-effective. Further studies to evaluate the running of telemedicine need to abating the practical and high-efficiency method, that can be done everywhere and it's free from mistakes and defects.

BackgroundDuring the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic.MethodsWe used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020.ResultsThirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic.ConclusionsOur results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.

Nature-based solutions (NBS) are being promoted as adaptive measures against predicted increasing hydrometeorological hazards (HMHs), such as heatwaves and floods which have already caused significant loss of life and economic damage across the globe. However, the underpinning factors such as policy framework, end-users' interests and participation for NBS design and operationalisation are yet to be established. We discuss the operationalisation and implementation processes of NBS by means of a novel concept of Open-Air Laboratories (OAL) for its wider acceptance. The design and implementation of environmentally, economically, technically and socio-culturally sustainable NBS require inter- and transdisciplinary approaches which could be achieved by fostering co-creation processes by engaging stakeholders across various sectors and levels, inspiring more effective use of skills, diverse knowledge, manpower and resources, and connecting and harmonising the adaptation aims. The OAL serves as a benchmark for NBS upscaling, replication and exploitation in policy-making process through monitoring by field measurement, evaluation by key performance indicators and building solid evidence on their short- and long-term multiple benefits in different climatic, environmental and socio-economic conditions, thereby alleviating the challenges of political resistance, financial barriers and lack of knowledge. We conclude that holistic management of HMHs by effective use of NBS can be achieved with standard compliant data for replicating and monitoring NBS in OALs, knowledge about policy silos and interaction between research communities and end-users. Further research is needed for multi-risk analysis of HMHs and inclusion of NBS into policy frameworks, adaptable at local, regional and national scales leading to modification in the prevalent guidelines related to HMHs. The findings of this work can be used for developing synergies between current policy frameworks, scientific research and practical implementation of NBS in Europe and beyond for its wider acceptance.

Nature-based solutions (NBS) are being promoted as adaptive measures against predicted increasing hydrometeorological hazards (HMHs), such as heatwaves and floods which have already caused significant loss of life and economic damage across the globe. However, the underpinning factors such as policy framework, end-users' interests and participation for NBS design and operationalisation are yet to be established. We discuss the operationalisation and implementation processes of NBS by means of a novel concept of Open-Air Laboratories (OAL) for its wider acceptance. The design and implementation of environmentally, economically, technically and socio-culturally sustainable NBS require inter- and transdisciplinary approaches which could be achieved by fostering co-creation processes by engaging stakeholders across various sectors and levels, inspiring more effective use of skills, diverse knowledge, manpower and resources, and connecting and harmonising the adaptation aims. The OAL serves as a benchmark for NBS upscaling, replication and exploitation in policy-making process through monitoring by field measurement, evaluation by key performance indicators and building solid evidence on their short- and long-term multiple benefits in different climatic, environmental and socioeconomic conditions, thereby alleviating the challenges of political resistance, financial barriers and lack of knowledge. We conclude that holistic management of HMHs by effective use of NBS can be achieved with standard-compliant data for replicating and monitoring NBS in OALs, knowledge about policy silos and interaction between research communities and end-users. Further research is needed for multi-risk analysis of HMHs and inclusion of NBS into policy frameworks, adaptable at local, regional and national scales leading to modification in the prevalent guidelines related to HMHs. The findings of this work can be used for developing synergies between current policy frameworks, scientific research and practical implementation of NBS in ...

BackgroundDuring the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic.MethodsWe used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020.ResultsThirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic.ConclusionsOur results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.

We study the modelling of the halo occupation distribution (HOD) for the eBOSS DR16 emission line galaxies (ELGs). Motivated by previous theoretical and observational studies, we consider different physical effects that can change how ELGs populate haloes. We explore the shape of the average HOD, the fraction of satellite galaxies, their probability distribution function (PDF), and their density and velocity profiles. Our baseline HOD shape was fitted to a semi-analytical model of galaxy formation and evolution, with a decaying occupation of central ELGs at high halo masses. We consider Poisson and sub/super-Poissonian PDFs for satellite assignment. We model both Navarro–Frenk–White and particle profiles for satellite positions, also allowing for decreased concentrations. We model velocities with the virial theorem and particle velocity distributions. Additionally, we introduce a velocity bias and a net infall velocity. We study how these choices impact the clustering statistics while keeping the number density and bias fixed to that from eBOSS ELGs. The projected correlation function, wp, captures most of the effects from the PDF and satellites profile. The quadrupole, ξ2, captures most of the effects coming from the velocity profile. We find that the impact of the mean HOD shape is subdominant relative to the rest of choices. We fit the clustering of the eBOSS DR16 ELG data under different combinations of the above assumptions. The catalogues presented here have been analysed in companion papers, showing that eBOSS RSD+BAO measurements are insensitive to the details of galaxy physics considered here. These catalogues are made publicly available. ; Santiago Avila is supported by the MICUES project, funded by the European Union's Horizon 2020 research programme under the H2020 Marie Skłodowska-Curie Actions grant agreement no. 713366 (InterTalentum UAM). VGP acknowledges support from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement no. 769130). SA is supported by the European Research Council through the COSFORM Research Grant (#670193). EMM was funded by the ERC under the European Union's Horizon 2020 research and innovation programme (grant agreement no. 693024). ; Peer reviewed

Nature-based solutions (NBS) are being promoted as adaptive measures against predicted increasing hydrometeorological hazards (HMHs), such as heatwaves and floods which have already caused significant loss of life and economic damage across the globe. However, the underpinning factors such as policy framework, end-users' interests and participation for NBS design and operationalisation are yet to be established. We discuss the operationalisation and implementation processes of NBS by means of a novel concept of Open-Air Laboratories (OAL) for its wider acceptance. The design and implementation of environmentally, economically, technically and socio-culturally sustainable NBS require inter- and transdisciplinary approaches which could be achieved by fostering co-creation processes by engaging stakeholders across various sectors and levels, inspiring more effective use of skills, diverse knowledge, manpower and resources, and connecting and harmonising the adaptation aims. The OAL serves as a benchmark for NBS upscaling, replication and exploitation in policy-making process through monitoring by field measurement, evaluation by key performance indicators and building solid evidence on their short- and long-term multiple benefits in different climatic, environmental and socio-economic conditions, thereby alleviating the challenges of political resistance, financial barriers and lack of knowledge. We conclude that holistic management of HMHs by effective use of NBS can be achieved with standard compliant data for replicating and monitoring NBS in OALs, knowledge about policy silos and interaction between research communities and end-users. Further research is needed for multi-risk analysis of HMHs and inclusion of NBS into policy frameworks, adaptable at local, regional and national scales leading to modification in the prevalent guidelines related to HMHs. The findings of this work can be used for developing synergies between current policy frameworks, scientific research and practical implementation of NBS in Europe and beyond for its wider acceptance.

Funding for the mhGAP Programme, under which the work reported in this manuscript was done, was provided by the following: American Psychiatric Foundation, USA; Association of Aichi Psychiatric Hospitals, Japan; Autism Speaks, USA; CBM; Government of Italy; Government of Japan; Government of The Netherlands; International Bureau for Epilepsy; International League Against Epilepsy; Medical Research Council, UK; National Institute of Mental Health, USA; Public Health Agency of Canada, Canada; Rockefeller Foundation, USA; Shirley Foundation, UK; Syngenta, Switzerland; United Nations Population Fund;World Psychiatric Association

Background: The Global Alliance for Chronic Diseases comprises the majority of the world's public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects. Methods: Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings. Results: There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focusing on fiscal measures, regulation and legislation.Conclusions: The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The ...